True Medical Detective Stories by Clifton Meador

Author:Clifton Meador [Meador, Clifton]
Language: eng
Format: epub, mobi
ISBN: 9781623450076
Publisher: CreateSpace
Published: 2012-07-16T07:00:00+00:00

Chapter Ten

Some Things Just Get

Under Your Skin

Sam Waffard lived in the country about thirty miles from the city. He had developed a strange illness that prompted repeated admissions to Vanderbilt Hospital.

The only history he gave was that he would notice a strange feeling over his chest and shoulders. Within a few hours he had shaking chills and high fever. Each time he came to the ER, he was admitted. Sam appeared to be a muscular, healthy young man in his early twenties. The only abnormality on physical examination, other than fever, was the finding of air under his skin over the front and back of his chest. The air extended to his shoulders and lower neck. The doctors told him it was called “subcutaneous emphysema.”

On each admission, cultures were taken from his blood and from samples of the gas under his skin. No bacterial organism was ever cultured. After the first few admissions, Sam had become famous to the medical residents and the faculty at the medical school. Each resident was determined to become the detective who would find the cause for the curious findings of air under the skin and high fever. Each time Sam was admitted, he began a course of antibiotics. The fever quickly went away and Sam recovered, only to be readmitted several weeks later.

No one had ever seen a case of high fever and spontaneous subcutaneous emphysema. Air under skin of the chest is well known to occur in some patients with rib fractures or penetrating wounds to the chest wall. Sam had neither. Air under the skin can also occur around surgical tracheostomy sites in the neck, where the air from the airway dissects out under the skin of the neck. Sam had never had a tracheostomy or any operation on his neck.

Cases as unusual as Sam’s nearly always get presented at the weekly grand rounds at the medical school. The case is presented by the resident, and the findings are discussed by the faculty. Sam’s case had been presented several times, but no one had come up with an explanation for the combination of air under the skin, infection, and fever. Various members of the faculty had suggested many different causes for the air to accumulate under the skin. Was there some hidden connection between his trachea and the skin? Or maybe there was a connection between his esophagus and the skin. Could there be a connection between his throat and the skin? All of these were excluded by radiographic studies. One faculty suggested that the infecting agent, which had never been cultured, might be some strange gas-forming bacillus. That possibility had never been tested, since none of the cultures grew bacteria for examination. Maybe this was a new disease.

There was one member of the faculty who was famous for making difficult diagnoses — for solving medical mysteries, which Sam’s case had become. Dr. Rudolph Kampmeier was known as a diagnostician without a peer, and he was called to see and examine Sam.

Dr. Kampmeier’s most recognized ability was taking the best histories around.

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